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<br /> Hc�z9 HENNEPIN COUNTY PUBLIC WORKS Permit No. ' :
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<br /> 320 Washington Avenue South ��
<br />$ Hopkins, Minnesota 55343
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<br /> � APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT
<br /> (Read "General Requirements" reverse side)
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<br />�`: Name of applicant Phone >
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<br />" Address
<br /> (city) (state) (zip code) �
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<br /> Name of Property Owner Address
<br /> 1. Contractor performing work Phone
<br /> 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) Public Street�s)
<br /> 3. Building to be constructed: o Yes � No � Residence o Commercial (Specify Type)
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<br /> 4. Driveway or street will be: � Temporary ❑ Permanent Date proposed entrance will be needed:
<br /> 5. Is the property: � Platted � Unplatted Number of present driveways or entrances to property:
<br /> 6. Building Permit acquired: � Yes � No City Permit No.
<br /> 7. Type of proposed entrance surface. � Bituminous o Concrete � Rock � Other
<br /> 8. Location
<br />\ (Address) (Co. Road) (City)
<br />�' 9. Location, if rural: Miles of �
<br /> (N.,S.,E.,or W.) (Road or Street) '�'
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<br />�".',�' Dated Applicant's Signature
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<br /> To help the inspector, place a stake with a cloth attached in the center of the proposed entrance, higher than any surrounding
<br /> vegetation.
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<br /> � APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted)
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<br />-?+% (Complete this form and send all copiesto:Hennepin County "+
<br /> k Highway Division, Traffic Office, 320 Washington Avenue
<br /> South, Hopkins, Minnesota 55343. Phone: 935-3381.
<br /> After approval, one copy will be returned to applicant.)
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